Pediatric Acute Care Examination Questions and
Verified Answers 2026-2027
Comprehensive Practice Test Bank & Clinical Assessment Guide for Pediatric Acute
Care
1. A 2-year-old child presents to the emergency department with a sudden onset of
stridor, barking cough, and mild intercostal retractions. The symptoms worsen at night.
Which initial pharmacologic management is most appropriate?
A. Intravenous ampicillin and inhaled albuterol
B. Oral dexamethasone and nebulized L-epinephrine if distress escalates
C. Oral azithromycin and warm humidified air
D. Inhaled ipratropium bromide and oral montelukast
Rationale: Croup (laryngotracheobronchitis) is managed primarily with a single dose of oral or
IM dexamethasone to reduce airway edema. Nebulized epinephrine is indicated for
moderate-to-severe stridor at rest.
2. A 6-year-old child with known sickle cell anemia presents with severe chest pain, fever
of 38.8°C, tachypnea, and new pulmonary infiltrates on chest radiograph. What acute
complication is occurring?
A. Acute Chest Syndrome
B. Aplastic Crisis
C. Splenic Sequestration Crisis
D. Vaso-occlusive Pain Crisis of the ribs
Rationale: Acute Chest Syndrome is defined by a new radiographically confirmed pulmonary
infiltrate accompanied by fever, chest pain, tachypnea, or hypoxia. It is a leading cause of
mortality in sickle cell disease and requires aggressive management.
3. An 18-month-old infant is brought to the clinic with a 3-day history of low-grade fever,
rhinorrhea, and progressive wheezing. On exam, the infant has nasal flaring, subcostal
retractions, and a respiratory rate of 64 breaths/min. What is the most likely underlying
etiology?
A. Mycoplasma pneumoniae
B. Respiratory Syncytial Virus (RSV) causing acute bronchiolitis
C. Haemophilus influenzae type b
D. Streptococcus pneumoniae
Rationale: RSV is the predominant cause of acute bronchiolitis in infants under 2 years of
age, presenting with viral upper respiratory symptoms followed by lower tract inflammation,
wheezing, tachypnea, and retractions.
, 4. A 4-year-old child admitted with severe septic shock remains hypotensive despite fluid
resuscitation totaling 60 mL/kg of isotonic crystalloid. Which vasoactive infusion is
recommended first-line for cold fluid-refractory septic shock in children?
A. Vasopressin
B. Nitroglycerin
C. Epinephrine
D. Milrinone
Rationale: Pediatric septic shock guidelines recommend epinephrine as the first-line
vasoactive agent for fluid-refractory cold shock (poor perfusion, delayed capillary refill) to
improve inotropy and vascular tone.
5. A 7-year-old child with type 1 diabetes mellitus is brought to the ED with lethargy, deep
rapid breathing (Kussmaul respirations), and a fruity breath odor. Laboratory results
reveal serum glucose 420 mg/dL and venous pH 7.12. Which step is essential during the
initial hour of fluid resuscitation?
A. Administer an isotonic saline fluid bolus (10–20 mL/kg) over 1 hour before initiating
continuous IV insulin.
B. Administer an immediate high-dose IV insulin bolus of 0.1 units/kg.
C. Infuse 5% Dextrose with half-normal saline at twice maintenance rate immediately.
D. Administer sodium bicarbonate IV push to correct acidemia.
Rationale: In pediatric DKA, initial fluid restoration with isotonic saline over the first hour
expands intravascular volume and improves renal perfusion. Insulin boluses are avoided to
prevent sudden osmotic shifts and cerebral edema.
6. An 8-month-old infant presents with sudden paroxysms of severe abdominal pain
during which he draws his knees up to his chest, followed by periods of normal behavior.
The mother reports a stool resembling red currant jelly. What diagnostic/therapeutic
procedure is indicated?
A. Emergency exploratory laparotomy
B. Ultrasound-guided air or contrast enema
C. Abdominal CT scan with oral contrast
D. Upper GI endoscopy
Rationale: Intermittent colicky pain with knees flexed and "currant jelly" stools are classic
signs of intussusception. An air or contrast enema serves as both the primary diagnostic test
and non-operative reduction treatment.
7. A 3-year-old child presents with high fever for 5 days, bilateral non-purulent
conjunctivitis, fissured red lips, a "strawberry" tongue, polymorphous rash, and
erythema of the palms and soles. Which initial treatment is crucial to prevent coronary
artery aneurysms?
A. Intravenous penicillin G and oral corticosteroids
B. High-dose Intravenous Immunoglobulin (IVIG) and high-dose Aspirin
C. Oral acyclovir and antihistamines
Verified Answers 2026-2027
Comprehensive Practice Test Bank & Clinical Assessment Guide for Pediatric Acute
Care
1. A 2-year-old child presents to the emergency department with a sudden onset of
stridor, barking cough, and mild intercostal retractions. The symptoms worsen at night.
Which initial pharmacologic management is most appropriate?
A. Intravenous ampicillin and inhaled albuterol
B. Oral dexamethasone and nebulized L-epinephrine if distress escalates
C. Oral azithromycin and warm humidified air
D. Inhaled ipratropium bromide and oral montelukast
Rationale: Croup (laryngotracheobronchitis) is managed primarily with a single dose of oral or
IM dexamethasone to reduce airway edema. Nebulized epinephrine is indicated for
moderate-to-severe stridor at rest.
2. A 6-year-old child with known sickle cell anemia presents with severe chest pain, fever
of 38.8°C, tachypnea, and new pulmonary infiltrates on chest radiograph. What acute
complication is occurring?
A. Acute Chest Syndrome
B. Aplastic Crisis
C. Splenic Sequestration Crisis
D. Vaso-occlusive Pain Crisis of the ribs
Rationale: Acute Chest Syndrome is defined by a new radiographically confirmed pulmonary
infiltrate accompanied by fever, chest pain, tachypnea, or hypoxia. It is a leading cause of
mortality in sickle cell disease and requires aggressive management.
3. An 18-month-old infant is brought to the clinic with a 3-day history of low-grade fever,
rhinorrhea, and progressive wheezing. On exam, the infant has nasal flaring, subcostal
retractions, and a respiratory rate of 64 breaths/min. What is the most likely underlying
etiology?
A. Mycoplasma pneumoniae
B. Respiratory Syncytial Virus (RSV) causing acute bronchiolitis
C. Haemophilus influenzae type b
D. Streptococcus pneumoniae
Rationale: RSV is the predominant cause of acute bronchiolitis in infants under 2 years of
age, presenting with viral upper respiratory symptoms followed by lower tract inflammation,
wheezing, tachypnea, and retractions.
, 4. A 4-year-old child admitted with severe septic shock remains hypotensive despite fluid
resuscitation totaling 60 mL/kg of isotonic crystalloid. Which vasoactive infusion is
recommended first-line for cold fluid-refractory septic shock in children?
A. Vasopressin
B. Nitroglycerin
C. Epinephrine
D. Milrinone
Rationale: Pediatric septic shock guidelines recommend epinephrine as the first-line
vasoactive agent for fluid-refractory cold shock (poor perfusion, delayed capillary refill) to
improve inotropy and vascular tone.
5. A 7-year-old child with type 1 diabetes mellitus is brought to the ED with lethargy, deep
rapid breathing (Kussmaul respirations), and a fruity breath odor. Laboratory results
reveal serum glucose 420 mg/dL and venous pH 7.12. Which step is essential during the
initial hour of fluid resuscitation?
A. Administer an isotonic saline fluid bolus (10–20 mL/kg) over 1 hour before initiating
continuous IV insulin.
B. Administer an immediate high-dose IV insulin bolus of 0.1 units/kg.
C. Infuse 5% Dextrose with half-normal saline at twice maintenance rate immediately.
D. Administer sodium bicarbonate IV push to correct acidemia.
Rationale: In pediatric DKA, initial fluid restoration with isotonic saline over the first hour
expands intravascular volume and improves renal perfusion. Insulin boluses are avoided to
prevent sudden osmotic shifts and cerebral edema.
6. An 8-month-old infant presents with sudden paroxysms of severe abdominal pain
during which he draws his knees up to his chest, followed by periods of normal behavior.
The mother reports a stool resembling red currant jelly. What diagnostic/therapeutic
procedure is indicated?
A. Emergency exploratory laparotomy
B. Ultrasound-guided air or contrast enema
C. Abdominal CT scan with oral contrast
D. Upper GI endoscopy
Rationale: Intermittent colicky pain with knees flexed and "currant jelly" stools are classic
signs of intussusception. An air or contrast enema serves as both the primary diagnostic test
and non-operative reduction treatment.
7. A 3-year-old child presents with high fever for 5 days, bilateral non-purulent
conjunctivitis, fissured red lips, a "strawberry" tongue, polymorphous rash, and
erythema of the palms and soles. Which initial treatment is crucial to prevent coronary
artery aneurysms?
A. Intravenous penicillin G and oral corticosteroids
B. High-dose Intravenous Immunoglobulin (IVIG) and high-dose Aspirin
C. Oral acyclovir and antihistamines
